The periodontal pocket cleaner is a device for removing foreign material from periodontal pockets and periodontal sulci and from the tooth surfaces adjacent to such pockets and sulci. The periodontal pocket cleaner is particularly useful for removing foreign material from interdental periodontal pockets.
The gingiva of the healthy periodontium is normally attached to the tooth and gives support to the tooth. The margin of the healthy gingival attachment includes a gingival sulcus, i.e. a slight recession of the gingival attachment which results in a small detachable space between the tooth and the surrounding gingiva at the margin. A periodontal pocket occurs if the recession of the gingival attachment extends beyond the normal sulcus.
The etiology of the formation of periodontal pockets is not fully understood. However, pathological sequelae to the formation of a periodontal pocket can be pernicious to the health of the periodontium. The growth and formation of bacterial plaque in the vicinity of the sulcus are a capital etiological factor in the formation of a pocket. After the periodontal pocket begins to form, the pocket will tend to accumulate more debris, including food particles. This accumulation of debris will further promote bacterial growth and bacterial plaque formation, and may lead to bacterial invasion of the gingival tissues and the excretion of bacterial toxins which can inflame the gingival tissues. The accumulation of debris and the subsequent bacterial infection within the periodontal pocket contributes to the pathological sequelae of pocket formation. The bacterial infection within a pocket can lead to the permanent resorption of the alveolar process, to the subsequent loss of support for the tooth, and to the eventual loss of the tooth itself. The bacterial infection within a pocket can also lead to apical migration of the attachment apparatus and the characteristic gum recession of periodontal disease. The bacterial infection may deter reattachment of the gingiva to the tooth and may promote further detachment of the gingiva from the tooth surface, thereby progressively increasing the size and depth of the periodontal pocket, enabling the pocket to accumulate more debris, and compounding the risk of further sequelae.
Removing accumulated materials from the periodontal pocket and destroying the bacteria will ameliorate some or all of the pathological sequelae of pocket formation. Unfortunately, the anatomy of the periodontal pocket inherently limits the accessibility to the pocket. After the formation of the pocket, the detached gingiva continues to lie as a sleeve against the tooth. Any device or agent for cleaning a periodontal pocket must enter through the pocket opening and reach into the deepest sections of the pocket. Interdental periodontal pockets have particularly limited accessibility.
An interdental periodontal pocket is a pocket situated interdentally between a papilla and the proximal surface of a tooth. The proximity of the adjacent teeth spatially hinders access to an interdental pocket for cleaning. Popular prior art devices such as the tooth brush, dental floss, and gum massagers are unable to penetrate completely into or to clean deeper interdental pockets because they are not structured to permit this kind of access. The pocket cleaner of the present invention is particularly efficacious for cleaning interdental periodontal pockets.
The present invention provides a periodontal pocket cleaner for sweeping through a periodontal pocket having deep recesses and for cleaning material from the deep recesses of the pocket and from tooth surfaces adjacent to the pocket, the periodontal pocket cleaner comprising:
a tapered end having an elongated shape, having a wooden composition with the grain of the wood running substantially parallel to the longitudinal direction, having a scoop surface running substantially parallel to the longitudinal direction and having a functional point, and
a handle end connected to said tapered end.
The periodontal pocket cleaner of the present invention is characterised in that:
(a) the wooden composition is a soft hard wood or a functional equivalent of soft hard wood; PA1 (b) the scoop surface which is preferably planar and narrow at the functional point and becomes progressively wider towards the handle end such that the scoop surface can be used for catching and scooping material from the deep recesses of the periodontal pocket; PA1 (c) said tapered end includes two scraping surfaces on either side of the scoop surface that extend substantially parallel to the longitudinal direction for scraping away material adhering to the tooth surface; PA1 (d) the cross-section of said tapered end taken perpendicular to the longitudinal direction is formed by the two scraping surfaces and the scoop surface with the two scraping surfaces converging in a direction away from the scoop surface, the scraping surfaces preferably being convex, e.g. of part-elliptical cross-section; PA1 (e) the composition and the dimensions of said tapered end are such as to impart sufficient strength, softness, and pliancy to said tapered end for enabling, for at least one time, said tapered end to be inserted into the deep recesses of the pocket, to sweep across the deep recesses of the pocket, and to remove material from the deep recesses of the pocket and the adjacent tooth surfaces without causing clinically significant risk of damaging tissues proximal to the pocket.
Dental floss can not reach the deeper recesses of peridontal pockets. The protocol for the use of dental floss requires that the floss first be stretched taut against a surface of a tooth in a direction approximately parallel to the gum line. The stretched floss is then moved up and down to remove material from the tooth surface. However, the movement of the floss is limited by the gingival attachment to the tooth. The recess of a pocket lies below the upper most gingival attachment and is substantially inaccessible to the cleaning action of floss. The periodontal pocket cleaner of the present invention is designed to reach the recesses of a pocket which are inaccessible to floss. Flossing sensitive teeth can sometimes cause discomfort. However, scraping plaque from sensitive teeth with a moistened pocket cleaner of the present invention is unlikely to cause discomfort because the cleaning surface of the pocket cleaner is soft and because the patient can directly control the pressure and course of contact between the device and the tooth.
A tooth brush may be of some utility for cleaning the lingual and labial aspects of periodontal sulci. However, action of the bristles of the tooth brush is crude for the task of cleaning pockets. The bristles may be unable to fully penetrate the deeper recesses of a periodontal pocket and action of the tooth brush as a whole is relatively indiscriminate. For cleaning interdental pockets, the utility of the tooth brush is negligible because of the spatial hindrance of the adjacent teeth.
Gum massagers are too bulky to penetrate the recesses of periodontal sulci and pockets. Gum massagers are designed to stimulate the gum and to clean tooth surfaces above the gum line. The periodontal pocket cleaner of the present invention shares some structural similarities to gum massagers. However, the crucial difference between the periodontal pocket cleaner and a gum massager lies in the ability of the pocket cleaner to penetrate the recesses of the periodontal sulci and pockets. Compared to gum massagers, the pocket cleaner has a much smaller size and a much narrower shape. While the reduced size and shape of the pocket cleaner reduces its structural strength compared to gum massagers, the pocket cleaner retains sufficient strength to sweep the sulci and pockets. The composition, size, and shape of the pocket cleaner are optimized for strength, but are consistant with the requirement that the pocket cleaner have access to the sulci and pockets. As a consequence, if the pocket cleaner is used as a gum massager, it is somewhat less durable than the typical gum massager.
One class of prior art device which is useful for cleaning the recesses of periodontal pockets includes dental curettes. Dental curettes are metallic devices designed to be used by dental hygienists or dentists for scraping and sweeping material from periodontal pockets. Curettes are not designed for patient use. Curettes are metallic and therefore cannot absorb material from the pocket, can not deliver antiseptics to the pocket, and are prone to cause tissue damage to the gingiva due to their hardness. The pocket cleaner of the present invention is distinguished from the curette because the pocket cleaner has a wooden composition; because the pocket cleaner is primarily suitable for patient use rather than clinical use; because removed blood and other pocket materials are absorbed by the pocket cleaner for better observation and for monitoring the state of pocket disease; and because the pocket cleaner can deliver medication to the pocket recess.
Another class of prior art device which is useful for cleaning the recesses of periodontal pockets includes periodontal brushes. A periodontal brush is a bristle brush with bristles attached to a twisted double wire. The assembly of bristles and twisted wire is designed to be inserted into periodontal pockets. The patient cleans his periodontal pockets by brushing out the pocket material. Because of the differences in composition between the periodontal brush and the wooden periodontal pocket cleaner of the present invention, they have markedly different properties. The soft hardwood of the pocket cleaner is absorbant and pliant so as not to damage the detached, frequently inflamed, gingival tissues surrounding the pocket; the soft hardwood also absorbs liquid materials including blood from the pocket in order to facilitate the observation of periodontal pathologies and to monitor the state of disease and inflamation of the pocket; the soft hardwood can also be used to deliver medication to the pocket recess; the soft hardwood pocket cleaner is disposable. The bristles of the periodontal brush cause the brush to be less effective for sweeping along the gingival attachment line than the wooden pocket cleaner.
Toothpick devices share some similarities with the periodontal pocket cleaner of the present invention. Both devices can be wooden and both devices may be used for cleaning tooth surfaces. However, tooth pick devices are adapted for dislodging food which is jammed between two teeth, while the pocket cleaner is adapted for scraping attached bacterial plaque from the root surface and sweeping loose material from pockets and sulci. Because tooth picks require considerable force to dislodge food jammed between two teeth, they require substantial structural strength and durability. Because of this, tooth picks are relatively large and hard and are therefore inappropriate for cleaning sulci and pockets. Because of its specilized function, the periodontal pocket cleaner lacks the size, strength, and durability of the tooth pick.
The most relevant prior art is disclosed by Marvin C. Weinstat, viz. FR-A-2,408,343. In this reference, Weinstat discloses a wooden device for cleaning periodontal pockets. Weinstat's device is similar in appearance to a round tooth pick having conical ends. However, one end of Weinstat's device includes an ellipsoidal, concave, elongated bevel cut into the cone. In use, the bevelled end of Weinstat's device is inserted into a periodontal pocket and rubbed against the tooth for removing plaque and other material from the pocket. When inserted into a periodontal pocket, the bevelled side of Weinstat's device lies parallel to either the tooth surface or to the opposing tissue which faces the tooth. In this configuration, the bevelled side of Weinstat's device serves as a "scrape surface." However, Weinstat does not teach that the bevelled side can also be employed for "scooping" material from the pocket. Indeed, when Weinstat's device is inserted into a normal periodontal pocket in the above-described configuration, the device can not then be axially rotated 90 degrees and swept within the pocket without significant clinical risk of tissue damage. Furthermore, the tooth and adjacent tissues which form a normal periodontal pocket would usually spatially constrain and prevent the bevelled side of Weinstat's device from being employed to scoop material from the pocket in a sweeping fashion. Consequently, Weinstat's device lacks the ability to scrape a tooth surface adjacent to a periodontal pocket while simultaneously scooping out material from the pocket by means of a sweeping motion. On the other hand, although it is not taught in the prior art, it would not be impossible to employ the bevelled side of Weinstat's device as a scoop surface outside of a periodontal pocket.
The periodontal pocket cleaner of the present invention is a device to be used by dental patients having a condition of periodontal pockets. The periodontal pocket cleaner should be used by dental patients having a diseased condition within their periodontal pockets due to poor periodontal hygiene; by individuals wishing to maintain the hygiene of periodontal pockets; and by individuals wishing to maintain the hygiene of their healthy periodontal sulci. Because of time and expense, the typical periodontal patient can make only periodic visits to a clinic to have periodontal pockets cleaned and treated. The dental patient uses the pocket cleaner principally for home care to maintain the hygiene and health of pockets between visits to the dental clinic. After each meal, the patient should manipulate the pocket cleaner to remove material from pockets. The pocket cleaner may be particularly useful for the home care of dental patients who have undergone peridontal surgery or who are candidates for peridontal surgery due to periodontal disease resulting in part from the formation of pockets.
The patient probes the pocket with the pocket cleaner and sweeps material from the pocket. The pocket cleaner has a tapered end with a functional point which sweeps through the pocket. As it sweeps through the pocket, the pocket cleaner scoops material from the pocket and scrapes plaque and other attached material from the adjacent tooth surfaces.
The pocket cleaner is preferably made from a soft hardwood or a wood of like properties. The best known composition is a basswood (Tilia). The wood is cut along the grain so that the grain is parallel to the direction of elongation of the device in order to maximize its strength and to avoid splintering. The tapered end of the pocket cleaner has a size and shape which enables the patient to insert the device into periodontal pockets without undue deformation of the detached gingival tissues which surround the pocket.
The patient moistens the tapered end of the pocket cleaner with saliva before using the device. The soft hardwood becomes more pliant after it is moistened. However, it retains sufficient strength to sweep the pocket and to scrape the plaque which is attached to the adjacent tooth surface. Softness and pliancy are required in order to avoid damaging the surrounding gingiva when the pocket cleaner sweeps the pocket and scrapes plaque from the adjacent tooth surfaces. The gingival tissues which surround and border the pocket can be inflamed and sensitive due to a pathology. However, the pocket cleaner does not deform or damage these tissues because of its size and shape and because of its softness and pliancy.
The wooden pocket cleaner absorbs blood and other liquids as it sweeps the pocket. Besides enhancing the ability to remove material from the pocket, the absorbency of the pocket cleaner enables the patient to monitor the health of the pockets. If the patient finds blood or pus on the pocket cleaner after sweeping a pocket, the patient has an indication of a diseased active site process.
The pocket cleaner can also act as a carrier for the delivery of medications, including antiseptics and antibiotics, for the treatment of diseased pockets. Either the manufacturer or the patient may load the wooden pocket cleaner with a medication which can be absorbed by the wooden composition for delivery to the pocket when the pocket cleaner is moistened.
Because of its shape, size, and pliancy, the pocket cleaner does not damage the detached gingival tissue surrounding the pocket. The pocket cleaner is suitable for frequent daily usage for as long as the interdental pocket persists.
The pocket cleaner is a disposable item. The pocket cleaner may be mass produced cheaply because of the relatively low cost of materials and manufacture. The disposability of the pocket cleaner makes it convenient. But more importantly, the disposability of the pocket cleaner promotes good hygiene in the treatment of diseased pockets by allowing the user to discard the device after each use and to use a clean new device for the next pocket. Using a clean new device for each pocket, particularly after cleaning a diseased pocket, will help to prevent cross contamination caused by the transfer of pocket materials from a pathological pocket to another pocket.
The periodontal pocket cleaner is novel because it is the first wooden device to be used by the patient for removing material from the deeper recesses of periodontal pockets by means of scooping and scraping.
The periodontal pocket cleaner is novel because it is the first device for daily home use by the dental patient which can act as a carrier for the delivery of medications to the deeper recesses of periodontal pockets.
The periodontal pocket cleaner is novel because it is the first wooden device which can be used by the dental patient to monitor the state of health of the deeper recesses of periodontal pockets by observing the presence or absence of blood or pus absorbed by the device after cleaning a pocket.